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The term “cause of injury” refers to the action, lack of action, or circumstances that resulted directly in the fatal injury.  The term “nature of injury” refers to the medical cause of the fatal injury or illness; this is often referred to as the physiological cause of death.  A fatal injury usually is the result of a chain of events; the first of which is recorded as the cause.

2006 total LODD  106

Cause of Death
Stress/Overexertion  54

Stress or overexertion is a general category that includes all firefighter deaths that are cardiac or cerebrovascular in nature, such as heart attacks and strokes, and other events such as extreme climatic heat exposure.  Classification of a firefighter fatality in this cause of fatal injury category does not indicate that a firefighter was in poor physical condition.  Firefighting is extremely strenuous physical work and is likely one of the most physically demanding activities that the human body performs.
 
Deaths Caused by Stress or Overexertion

Year    Firefighters    Percentage
2006        54                51
2005        62                54
2004        66                56

Medical nature of the fatal injury or illness. 
Heart Attack  50
CVA  4

Eighteen firefighters died of heart attacks that struck after the conclusion of an incident response or on duty period: (These firefighters suffered heart attacks within 24 hours of an on duty stressful or strenuous activity).

Nine firefighters experienced heart attacks while on duty but not assigned to an incident, or participating in training:

Eight firefighters died of heart attacks that struck while they were working on the scene of a fire incident:
– Seven of the heart attacks struck as firefighters worked on the scene of structure fires.
– One heart attack struck as the firefighter worked at the scene of a wildland fire.

Seven Firefighters suffered heart attacks while responding to an incident.

Five firefighters were involved in training activities when they had heart attacks.
– Four firefighters experienced heart attacks during or shortly after physical fitness training activities.
– A Virginia firefighter died of a cardiac-related illness during an extrication demonstration.

Three firefighters became ill and died of heart attacks that struck while they were assigned to nonfire emergencies.  All three occurred at motor vehicle crash scenes.

Age at time of Death    Fire-fighters
    Under 21                       1
    21 to 25                        1
    26 to 30                        1
    31 to 35                        1
    36 to 40                        6
    41 to 45                        6
    46 to 50                        10
    51 to 60                        20
    61 and over                   10
Table includes 2 in the "Other" category.
26 of the 54 firefighters were 50 years old and younger when they died.

A Stressful event seems to be a major contributing factor in firefighter heart attack deaths, and this can happen to firefighters at any age.

To view the full report: www.usfa.dhs.gov  Search "2006 firefighter annual report"   

Captain Suffers Sudden Cardiac Death During Physical Fitness Evaluation - Alabama
SUMMARY
On April 25, 2007, a 56-year-old male career Captain was participating in the Fire Department's annual "Fit Check" (physical fitness) evaluation. The Captain successfully completed the bench press, sit-ups, and sit-and-reach portions of the evaluation within the allotted time. During the aerobic capacity (3-mile walk) portion of the evaluation, he completed 6 of 12 laps around the ¼-mile track, when he suddenly collapsed. Crew members on the scene responded and found him unresponsive, not breathing, and with a weak pulse that stopped shortly thereafter. Approximately 29 minutes later, despite cardiopulmonary resuscitation (CPR) and advanced life support administered on-scene and at the hospital, the Captain died. The death certificate and the autopsy, completed by the County Medical Examiner, listed "complications of atherosclerotic cardiovascular disease" as the immediate cause of death with "cardiomegaly" as a significant condition.
NIOSH investigators offer the following recommendations to address general safety and health issues. However, it is unclear if any of these recommendations would have prevented the Captain's sudden cardiac death.